Abdominal surgery is used to treat a variety of diseases and conditions. Techniques for performing abdominal surgery have made major advances during the past 150 years. Originally, surgeons made incisions in the abdominal wall sufficiently large to allow the surgeon to insert both hands into the abdominal cavity to gain easy access to the abdominal organs and to examine the abdominal organs by touch. This surgical method is referred to as “open surgery.”
During the 1980's and 1990's, a new form of surgery called “laparoscopic surgery” (standard laparoscopic surgery) was developed that required several smaller incisions of between 5 mm and 20 mm each to create ports for the placement of specialized instruments into the abdominal cavity. Recovery from laparoscopic surgery generally requires less time, is less painful and has fewer complications associated with abdominal wall incisions than does open surgery.
Several forms of laparoscopic surgery have been developed, including “laparoendoscopic single-site surgery” (LESS), where a single incision between 20 mm and 50 mm is made in the crease of the umbilicus and all instruments are introduced into the abdominal cavity through the one incision. The resultant cosmesis is improved in laparoendoscopic single-site surgery (LESS) compared with other forms of laparoscopic surgery because the single scar from laparoendoscopic single-site surgery (LESS) is concealed in the umbilicus, although the single incision is longer in length compared to other forms of laparoscopic surgery. Performing laparoendoscopic single-site surgery (LESS), however, is technically more difficult for the surgeon than other forms of laparoscopic surgery because the surgeon loses the mechanical advantage of triangulating several instruments from different angles that is available with standard laparoscopic surgery.
Another form of laparoscopic surgery called “natural orifice transluminal endoscopic surgery” (NOTES) has been developed where some of the laparoscopic instruments are introduced into the abdominal cavity through natural orifices (the mouth, urethra, anus and vagina), thereby hiding the resultant surgical access scars inside the body. Natural orifice transluminal endoscopic surgery, however, is technically more difficult to perform than standard laparoscopy in both sexes, and is more difficult to perform in men than women because men lack a vaginal canal and thus lack that source of access into the abdominal cavity.
Another form of laparoscopic surgery called “needlescopic surgery” uses devices introduced through ports using 2 mm and 3 mm openings in the abdominal wall. Two millimeter ports leave no visible scar. Three millimeter ports leave small visible scars that are difficult to see even by trained medical personnel. The major limitation on the development of the needlescopic surgery has been the poor functionality of the instruments that fit through the very small ports. Further, instruments that fit through 2 mm ports generally have shafts that are too short to be used in adult sized patients. Additionally, some abdominal procedures require instruments that need larger ports than 3 mm for placement in the abdominal cavity. Because of these limitations, needlescopic surgery has not gained popularity despite potential advantages for cosmesis and patient recovery.
Therefore, there is a need for a new surgical procedure that combines the broad usefulness of standard laparoscopic surgery with its multiple incisions that allow triangulation of instrumentation, but with the improved cosmesis of laparoendoscopic single-site surgery, natural orifice transluminal endoscopic surgery and needlescopic surgery.